Monday, August 3, 2009

Preparing for departure, final refelections

Hard to believe I worked my last official day at the hospital this past Friday, July 31st. That means I am in my final week here, preparing to head back for the U.S. on August 8th. After almost three months of living here it feels a little bittersweet, people have made me feel like a part of the community here and I have been here long enough that I seem to run into people I know from work or social circles at random places around town. Not knowing if I will ever see some of these people again, it is sad to say goodbye, but I’d like to think that we are at least better off for having known and influenced each other in some regard. My overall experience working in the labor and delivery department has been very rewarding and insightful. It has been a little tough at times to see some of the young mothers who come in. Sometimes the mother can only guess at her actual age, since birthdates are not always officially recorded, especially in more rural areas. I recently spoke with a girl being admitted to collect a brief history from her, and she told me she was 15 years old, but approximated her birth date as sometime in December of 1996, which would mean she would be turning 13 in December of this year, so I was not quite sure how to document even her approximated age. I then asked to get some signatures from her on some of the hospital admission forms and she told me that she was unable to read the forms or even sign her own name, having never had formal education, she was completely illiterate. I was not quite sure how to react to this, and the nurse I was working with instructed her to just write her name on the paper the best she could looking at a typed example of her own name. On one level I tell myself not to be surprised or judgmental when encountering people with complete illiteracy. I know that for a majority of the illiterate people here, it is simply a matter of not having had access to that type of education, something which it is easy to take for granted coming from a country where primary education is much more accessible and obligatory. On another level, I tell myself that my being literate and her not, in no way makes me more of a person. It is perfectly possible that in the community she comes from, literacy may not be a necessary tool of daily life, and I am sure that there are necessary skills in her community that I do not posses. But for whatever it is worth, I think literacy, in any language, can be a great tool no matter where you live as an additional means of communication. And in this country, which struggles with such high levels of economic poverty, I would think a community that had access to literacy and education would embrace it, even if only as a means to increase economic prospects in the future. But given the distribution of resources here in Nicaragua, many communities still do not have access to that type of learning, and even if they had the access, the time to dedicate would be another issue. Many of the people in the poorer communities work 6-7 days a week, often 10-12 hours a day, for an equivalent of $60-80 U.S. dollars per month. Here in Masaya, I spoke with a woman who commutes here daily on bus from her home near Managua. She works here in Masaya as an empleada, or house keeper (cooking, cleaning, hand washing laundry, running errands, etcetera) for another family. She has two young children that she brings with her to work, as there is no one at her home that could care for the children for that duration of time. She comes here 6 days a week, arriving at 7am and working until 6-7pm, for $80 per month. However, something I have had many discussions over with “middle-class” Nicaraguan people, is that even having an education and set of skills here in no way guarantees a life without sufficient economic hardship. Many of the workers in government and public service receive little compared to equivalent positions in other countries. For example, many of the nurses I have worked with at the hospital receive only a U.S. dollar equivalent of $250-400 per month for full-time employment, depending on their specific level of training and responsibilities in the hospital. In Nicaragua, that amount is surely enough to survive off of and keep a roof over your head, but for the nurses with children that they want to send to school, or caring for elder relatives, the salary is often just not enough. This moves many to take on a second job at a separate health clinic or private hospital to provide enough financial support, but at the cost of less physical time present with their families…something which can create other long-term costs. In addition to the public health workers being underpaid, other service sectors endure similar hardship, such as the police force. Many people here have told me that for an individual police officer to get by financially, because of the low wages, he/she often resorts to relying on bribes or other illicit funds. This obviously weakens meaningful police enforcement and protection from criminals in the community and leads to deeper corruption. All of this might be excusable by many of the people I have talked with if EVERYONE here was enduring a similar level of financial struggle, but what upsets them most is that the majority of citizens here endure these burdens, such as poor access to education and infrastructure, under funded health services, poor wages for the majority of public service employees, while the TAX FUNDED politically elected officials in the country receive wages, paid in U.S. dollars, far superior. One public health physician told me that a national assembly member here in Nicaragua earns $5,000-6,000 per month…almost double what an entry-level nurse here makes in a year. But I will leave my political rambling at that for now (I am technically supposed to be apolitical, but being my parent’s son that can be hard to do, ha ha). On a personal level my time here has been very meaningful. The staff in both departments I worked in, emergency and labor and delivery, have told me they really enjoyed having me around and are sad to see me go. They said I was the first “gringo” to come alone, spend time in their respective departments and actually work alongside them as equals and converse and break bread together. Apparently, they often get visitors from the U.S. and other countries, but they often come in small groups, stay a very short time, only observe, and speak little if at all with the actual staff, instead speaking only amongst themselves. While my Spanish still has a way to go, they were impressed with what I have learned and really appreciated my efforts in communicating with them and the patients. And certainly I feel this was probably the most “sustainable” aspect of my time here, being able to build those relationships and trust with some of the people here, in a way that if I am able to come back and work here again, I will already have a meaningful link to the community (although I would say that reorganized med cabinet in the emergency dept is a small improvement over what was there beforehand, and I was also able to provide some additional sphygmomanometers, stethoscopes, and a printer for the emergency department, things which they have always been short handed on or unable to attain). So I don’t know, it’s hard to describe my time here. This was my first time in a developing country in other than a military capacity…and having to deal with people without using and/or receiving the constant threat of force and physical destruction definitely changes the way you are able to relate to people, there is a stronger sense of genuine cooperation as opposed to coercion. And I definitely like the approach here of working through the local community organizations that are already here to try and improve conditions for the people in one aspect or another, as opposed to what I experienced in years past, which was generally a forceful external implementation of social/political change…and the consequences of that still have not resolved. Coming here to Nicaragua has also enriched the learning that took place prior to this trip. When our student group was selected back in January/February earlier this year, we met once a week to discuss the history and current situations in Nicaragua, as well as the more broad topic of development work. The classes were very informative and I feel they did a good job of preparing our group of students for coming here. Once I arrived everything we learned and discussed took on a much more personal meaning. Instead of reading words on a page or notes on a lecture slide, I could see and hear the Nicaraguans talking about the conditions and problems here and the direct impact on their lives. I got to work in a local hospital and experience the frustration of trying to care for people without adequate resources, something that the staff here deals with on a day-to-day basis. All of this is so much more powerful than learning in a strictly academic environment; learning through actual service (hence the term “service-learning”) gives you exposure for a genuine visceral reaction that is not easily forgotten. I only hope that I can take this experience from today and use it as a foot forward in serving whatever community I am a part of, whether it is back in the U.S. and/or returning here at some point once I have finished school. A thousand thanks to the Sarlo Foundation, FSD, and USF for making this opportunity possible for me, I would not have been able to come here without the financial support that was provided.While this is my last narrative post on this blog, I will post more photos of my last week here by sometime next week, so don’t hesitate to check back then. I will also post a copy or link to my research paper stemming from my research here, once it is completed, although that may not be until August 21, when it is due to be submitted. Please don’t hesitate to email or post comments about additional questions you have for me. Thanks to everyone who actually took the time to read this, ‘hope it has been worth the effort in one form or another…

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I am a student intern working for the Foundation for Sustainable Development (FSD). Any opinions or reader comments expressed by me or others in this blog do not necessarily reflect the opinions of FSD.